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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

99mtechnetium diphosphonate was used in 81 patients for myocardial imaging. 46 of the patients suffered, 2-6 days prior to the test, from an acute transmural infarction provided by clinical, ECG, and enzymatic evidence; the scintigram was definitely positive in 43, equivocal in 2, and negative in 1. In 16 patients with subendocardial infarctions, in 9 the scintigram showed a positive result, in 1 it was equivocal, and in6 patients negative. In 6 other patients who suffered from acute chest pain, followed by enzyme changes, but no ECG evidence of infarction throughout the hospitalization period, the scan was positive in all. In 13 patients with acute ischemia (unstable 'crescendo' angina), 9 had a positive, 1 an equivocal, and 3 a negative scan. We conclude that radionuclide imaging is a valuable addition to the methods already available for diagnosis of myocardial infarction. With the use of diphosphonate as the tracer, we found that acutely ischemic myocardium that later may recover, gives also positive imaging.
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PMID:Radionuclide imaging of the heart in myocardial infarction and acute ischemia by 99mtechnetium diphosphonate. 59 Feb 93

Patients with mitral valve prolapse (MVP) frequently experience chest pain which may, expecially in older subjects and males, be difficult to differentiate from angina pectoris. Electrocardiographic (ECG) changes, ventricular arrhythmias, metabolic abnormalities and rare reports of myocardial infarction and sudden death further suggest the presence of an ischemic process in these patients. The recognition of accompanying coronary artery disease (CAD) and exclusion of other causes of ischemia, therefore, may be important in determining the prognosis and appropriate therapy for such patients.
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PMID:Myocardial perfusion scintigraphy in patients with mitral valve prolapse: Its advantage over stress electrocardiography in diagnosing associated coronary artery disease and its implications for the etiology of chest pain. 61 88

To determine whether the extensive myocardial injury associated with cardiogenic shock in some patients results from a progressive rather than a discrete massive insult, a study was made of 15 selected patients who had cardiogenic shock within 48 hours of admission, 5 patients with hypovolemic shock without myocardial infarction and 11 patients with myocardial infarction without shock. Peak plasma MB creatine kinase (CK) activity was significantly higher in the seven patients with cardiogenic shock associated with initial infarction (213 international units [IU]/liter) than in patients with shock and previous infarction (98 IU/liter) and in patients with uncomplicated myocardial infarction (125 IU/liter). A prolonged time to peak MB CK activity (averaging 26 hours) and a plateau of elevated MB CK activity were seen in patients with shock associated with initial infarction. Because shock itself did not slow the rate of apparent MB CK disappearance, results obtained suggest that cardiogenic shock associated with initial infarction in selected patients results from progressive myocardial damage underlying continuing release of MB CK into the circulation. The findings are compatible with the concept that, in these patients, cardiogenic shock reflects a vicious cycle of spreading myocardial injury, progressive compromise of cardiac function, exacerbation of ischemia and perpetuation of myocardial damage.
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PMID:Progressive nature of myocardial injury in selected patients with cardiogenic shock. 62 24

Myocardial ischemia at rest occurs only late in the course of coronary artery disease, but transient ischemia can often be induced by increasing myocardial oxygen demand with exercise or atrial pacing. Myocardial ischemia causes a series of physiologic abnormalities that can be detected by assessment of myocardial perfusion, regional mechanical function, electrophysiology, and metabolism. Methods of assessment vary widely in sensitivity, specificity, cost, and ease of application. Although the appropriate choice of diagnostic test may be difficult, the morbidity and mortality that result from myocardial ischemia and infarction and the demonstrated potential of coronary artery bypass surgery to reverse myocardial ischemia before the development of permanent sequellae make the detection of ischemia an important clinical problem. Present methods for quantitating myocardial ischemia are imprecise and difficult to apply but have been used successfully to evaluate the efficacy of therapies designed to reduce the size of myocardial infarction.
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PMID:Myocardial ischemia: detection and quantitation. 62 55

The operative results in 32 patients who underwent aortic valve replacement with aortic occlusion and normothermic myocardium (group 1) were compared with 54 similar patients in whom the myocardium was protected by hypothermic coronary perfusion through the aortic root (group 2). The operative mortality and the incidence of heart failure, subendocardial ischemia and myocardial infarction were the same in the two groups. The maximal concentrations of cardiac enzymes after operation in group 2 patients were significantly lower than those in group 1. The postoperative cardiac performance was significantly different in that only 5.6% of group 2 patients required inotropic agents after operation compared with 25% of group 1 patients. The patients in group 2 were easier to defibrillate after cardiopulmonary bypass.
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PMID:Myocardial protection during aortic valve replacement: normothermia versus hypothermia. 63 Apr 59

Although many patients with coronary artery disease (CAD) have a positive exercise test without pain, the frequency and significance of this "silent" ischemia is unclear. Therefore, we studied 122 consecutive clinically stable patients with angiographically defined CAD (greater than 75 per cent luminal stenosis) and a positive exercise test. Seventy-eight patients had pain or anginal equivalent during or after a positive exercise test; 44 did not, including 32 (26 per cent) with no symptoms at all. Patients were evaluated as to age, sex, prior myocardial infarction, congestive failure, hypertension, diabetes mellitus, and digoxin or propranolol therapy--in addition to anginal symptoms before, during, or after the exercise itself. Extent of CAD, presence of collaterals, and left ventricular ejection fraction were also determined. All exercise tests were evaluated for evidence of ST-T abnormalities or prior infarction on the control ECG as well as peak heart rate during exercise and post-exercise degree of ST segment depression. There were no significant differences between patients with and without exercise-induced pain in regard to any of the clinical and angiographic features noted above, demonstrating that "silent" myocardial ischemia during or after exercise testing is not uncommon and is not readily attributable to any obvious clinical or catheterization findings. Further studies are necessary to determine if patients with evidence of "silent" myocardial ischemia are especially prone to sudden death.
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PMID:"Silent" myocardial ischemia during and after exercise testing in patients with coronary artery disease. 63 80

201Thallium scintigraphy serves as a non-invasive method for visualizing regional perfusion, viability and configuration of the myocardium. Serial scans performed after injection during ergometric exercise allow to differentiate between irreversible cell damage, i.e. myocardial infarction or scar, and transient, reversible ischemia in patients with coronary heart disease. ECG-gated blood pool scans are an ideal adjunct as they represent the functional results of the pathologically altered myocardium. This method permits quantitative determination of the enddiastolic volume, endsystolic volume and left ventricular ejection fraction. Furthermore, regional and global wall motion may be judged qualitatively. Results of both methods show an excellent correlation with those obtained by invasive catheterization and cineangiocardiography. The clinical value is based on screening and follow up of a broad variety of cardiac diseases.
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PMID:[Non-invasive nuclear medical diagnosis in cardiology. 201T1-myocardial and ECG triggered heart ventricle scintigraphy]. 64 May 62

Four cases of longitudinal dissociation of the atrioventricular node, with dual pathways developing during the acute phase of an inferior wall myocardial infarction (three cases) or during acute ischemia (one case), are presented. In all four cases, two grossly different P-R intervals were recorded, and in two cases, studies of the His bundle confirmed the location of the dissociation within the atrioventrcular node. In one case, premature atrial depolarization caused a bidirectional shifting of P-R intervals, while in the remaining three cases, premature ventricular depolarization (spontaneous or pacemaker-induced) was responsible for this phenomenon. In all cases, evidence of longitudinal dissociation of the atrioventricular node appeared during the acute phase of the infarction or ischemia, and in all of them the phenomenon was transient. This favors the assumption that this phenomenon is of a functional nature, most probably related to the ischemic lesion of the atrioventricular node.
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PMID:Dissociation of the atrioventricular node in acute inferior wall myocardial infarction. 2. Longitudinal dissociation (dual atrioventricular nodal pathways). 64 18

Male and female, arteriosclerotic and non-arteriosclerotic rats were treated with the anti-lipemic agent, clofibrate, for 8 days and then subjected to an acute myocardial infarction by injecting them with two large doses of isoproterenol spaced 24 hours apart. The animals were killed at sequential time intervals during the acute necrosis and early repair phases of myocardial infarction. Pre-treatment with clofibrate caused a definite improvement in survival, less shock and prostration, and ECG evidence of little or no ischemia. Increased SGOT levels, hepatic lipid and necrosis were indicative of advanced liver damage. Although clofibrate-treated animals showed little change in serum lipids during the acute cardiac necrosis phase, they were hyperglycemic and showed the greatest increase in BUN levels. Clofibrate-treated animals had higher serum corticosterone levels than those given isoproterenol alone. Despite superior survival rates, both the arteriosclerotic and non-arteriosclerotic, clofibrate-treated animals exhibited equally severe histopathologic evidence of myocardial damage. It is suggested that the protective effect of prophylactic treatment with clofibrate against isoproterenol-induced myocardial infarction in rats may be due to its ability to change corticosterone levels in the circulation.
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PMID:Protective effects of clofibrate on isoproterenol-induced myocardial infarction in arteriosclerotic and non-arteriosclerotic rats. 66 86

Ninety-seven patients with a prior transmural myocardial infarction who underwent coronary angiography and treadmill stress testing were studied retrospectively to assess the reliability of the exercise electrocardiogram in detecting additional disease in patients with a prior infarction. In patients with a previous inferior wall infarction, the S-T response to the treadmill stress test had a high degree of sensitivity (87 percent) and specificity (90 percent) in detecting additional significant coronary artery disease. However, in patients with a previous anteroseptal wall infarction, the S-T response had much less sensitivity (52 percent), but the degree of specificity remained high (90 percent). In this group a positive test suggested the presence of ischemia in the lateral or inferoposterior region of the myocardium, or both. A negative S-T response was of little value in distinguishing among groups of patients with single or multiple vessel coronary artery disease. The presence of an anterior ventricular aneurysm is most likely responsible for this low sensitivity rate because it generates an opposing force to the ischemic vector, thereby cancelling the S-T segment changes and producing a false negative treadmill stress test. The resting surface electrocardiogram proved useful in predicting a false negative exercise test. The presence of Q waves in the precordial leads extending to lead V4 or beyond decreased the sensitivity rate of treadmill stress testing to 33 percent.
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PMID:Comparison of S-T segment changes on exercise testing with angiographic findings in patients with prior myocardial infarction. 67 32


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